Rising cost and an aging population
In many industrialized countries healthcare services are under constant pressure from rising costs and an aging population. Reform is difficult, having to find a balance between what we would like to have in healthcare and what we can afford and organize. Changing the system often entails just that: changing the entire system, for everything is interdependent. Hence the trepidation of many a government. Very interesting are the different approaches countries have opted for in designing their national healthcare systems, offering a wide variety of public/private approaches. This is a fertile field for best-practice research.
One of the basic tenets of society is that the strong care for the weak. This can be accomplished in many ways, government intervention is but one of them. The principle of solidarity is however firmly entrenched in the collective psyche of most societies.
The Western tendency towards individualism and growing consumerism can potentially undermine solidarity. Adopting a free market approach to health in which people directly buy the care and cure they need, could disassociate the strong from the needs of the weak.
Is it possible to opt for a free market for healthcare and still maintain a strong bond of solidarity?
Public or private provision of healthcare?
National healthcare services are plagued by money shortages, inefficiencies, lack of innovative thinking and are woefully resistant to change. Private industries can suffer from the same, but at least that will mark the end of that particular organization: bankruptcy is the ever-present Sword of Damocles.
“The question is how to best serve the public interest”
But if you privatize it all, can you be sure that all the services you want will be provided? And can you be sure that prices and fees dont soar to great heigts? And can you be sure that enterprises arent cutting corners for the sake of profitability? Probably not. So government will stay involved somehow. It comes down to picking the model you like best and getting your toolbox to fix whatever problems come with the design you chose.
Government planning or allocation by the market?
This dilemma is closely related to the dilemma whether to opt for public or pivate service provision but not identical. The question here concerns the precarious balancing act a government has to master. If one were to visualize it, planning would be on one side of the spectrum and free market allocation on the other. Clearly both ends of the spectrum have their own, distinct problems and it is up to the government to find a place along the spectrum where it feels it can best serve the public interest.